Appl Clin Inform - Reducing risk with clinical decision support: a study of closed malpractice claims.

Tópicos

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Resumo

JECTIVE: Identify clinical opportunities to intervene to prevent a malpractice event and determine the proportion of malpractice claims potentially preventable by clinical decision support (CDS).MATERIALS AND METHODS: Cross-sectional review of closed malpractice claims over seven years from one malpractice insurance company and seven hospitals in the Boston area. For each event, clinical opportunities to intervene to avert the malpractice event and the presence or absence of CDS that might have a role in preventing the event, were assigned by a panel of expert raters. Compensation paid out to resolve a claim (indemnity), was associated with each CDS type.RESULTS: Of the 477 closed malpractice cases, 359 (75.3%) were categorized as substantiated and 195 (54%) had at least one opportunity to intervene. Common opportunities to intervene related to performance of procedure, diagnosis, and fall prevention. We identified at least one CDS type for 63% of substantiated claims. The 41 CDS types identified included clinically significant test result alerting, diagnostic decision support and electronic tracking of instruments. Cases with at least one associated intervention accounted for $40.3 million (58.9%) of indemnity.DISCUSSION: CDS systems and other forms of health information technology (HIT) are expected to improve quality of care, but their potential to mitigate risk had not previously been quantified. Our results suggest that, in addition to their known benefits for quality and safety, CDS systems within HIT have a potential role in decreasing malpractice payments.CONCLUSION: More than half of malpractice events and over $40 million of indemnity were potentially preventable with CDS.

Resumo Limpo

jectiv identifi clinic opportun interven prevent malpractic event determin proport malpractic claim potenti prevent clinic decis support cdsmateri method crosssect review close malpractic claim seven year one malpractic insur compani seven hospit boston area event clinic opportun interven avert malpractic event presenc absenc cds might role prevent event assign panel expert rater compens paid resolv claim indemn associ cds typeresult close malpractic case categor substanti least one opportun interven common opportun interven relat perform procedur diagnosi fall prevent identifi least one cds type substanti claim cds type identifi includ clinic signific test result alert diagnost decis support electron track instrument case least one associ intervent account million indemnitydiscuss cds system form health inform technolog hit expect improv qualiti care potenti mitig risk previous quantifi result suggest addit known benefit qualiti safeti cds system within hit potenti role decreas malpractic paymentsconclus half malpractic event million indemn potenti prevent cds

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